Mild Cognitive Impairment Activity Participation Functional Difficulty Adaptations

Mild Cognitive Impairment, Activity Participation, Functional Difficulty, & Adaptations in Functionally Vulnerable Elderly People Laraine Winter, Ph. D. & Laura N. Gitlin, Ph. D. Presented at GSA 2006

Mild Cognitive Impairment (MCI) Patients do not meet criteria for dementia but manifest related clinical features including loss of memory and executive function. MCI is hypothesized to represent an intermediate stage between normal age-associated changes and pathological features of Alzheimer’s disease (AD).

Value of Recognizing MCI -identify elders at risk and advance prompt diagnosis and treatment. - families of elders with MCI experience significant caregiver burden even at this early stage of impairment.

Purpose of Study n to identify predictors of MCI, focusing on -functional difficulties -adaptations to functional difficulties -participation in leisure activities

Participants n n n 127 ABLE participants MMSE score > 23 Functionally vulnerable (reporting need for help or difficulties with one or more ADL or two or more IADL)

Age Mean (sd) Range 78. 3 (5. 1) 70. 2 -92. 2 Percent Race (% African-American) 44. 1 Gender (% female) 80. 3 Education (% > HS) 44. 1 Financial WB score* 2. 4 (1. 1) 1 -4 Marital status (% married) 19. 7 MCI score 3. 9 (2. 6) 0 -15 Depression score (CES-D) 13. 8 (11. 3) 0 -48 MMSE at Baseline 27. 1 (1. 8) 24 -30 MMSE at 12 months 26. 8 (2. 4) 17 -30

Measures Baseline: n n n index of leisure activity participation MMSE CES-D 6 ADLs, 6 IADLS, 6 mobility items self-reported use of 4 types of adaptations: use of assistive devices, help from others, change in frequency, change in mode demographic characteristics

Leisure Activities Gone to a senior center or attended a senior citizen’s group Painted pictures or played a musical instrument Attended a church or synagogue service Eaten at a restaurant for a special occasion with friends/relatives Gone to meetings of a church group or other groups or clubs Baby-sat for grandchildren or other children Gone to the movies, theater, concerts, or lecture Gone out of town for vacation or to visit friends/relatives Gone to a sporting event Done volunteer work Participated in a sport like swimming, fishing hunting, bicycling, golf Done any baking Played cards, bingo, pool, or some other game Done any reading Taken care of house plants or done any outdoor gardening Taken care of a pet Worked on a hobby or handwork like sewing, knitting, or woodworking Watched TV or listened to the radio Other activity

Measures, continued 12 -month follow-up: The MCI battery MMSE measures of activity participation CES-D

MCI Battery Tasks Instructions Scoring Clock Draw the face of a clock, putting in the numbers and setting the hands to eight-twenty or twenty after eight. 3= severely impaired 2= moderately impaired 1= mildly impaired 0 = normal Animal naming Name all the animals you can think of in 60 seconds. 3= fewer than 5 2 = 5 -8 1 = 9 -12 0 = 12 or more After being given the first example (100 -3=97), participants subtract three from each successive number, starting with 97. One point is given for each incorrect number, to a maximum of 4 errors. Delayed intentional recall repeat and remember three words (ball, flag, tree). The number of words not recalled is scored, with a maximum of 3. 19 Spatial and temporal orientation Tell me your street and number, town or city, zip code, and phone number with area code. What is the day of the week, the month, date, and year? Up to 8 errors are recorded. (verbal fluency) Serial subtractions by (a test of mental control) Total MCI score number of errors for each test was recorded, yielding a possible range of 0 to 22. 5 or higher = MCI or worse

Data analyses n n Three separate multiple regression (MR) analyses, each using MCI as the dependent variable and entering demographic characteristics, mood, baseline MMSE score, and treatment assignment in block 1. The first MR entered the count of leisure activities, the second the 17 activities of daily living and mobility items, and the third the 4 types of functional adaptations in block 2

Results n n At 12 months, nearly 40% scored in the MCI range or worse. Mean MMSE dropped slightly from baseline, with 10. 1 percent scoring below 24.

Leisure Activities Lower participation at baseline was associated with higher MCI at 12 month follow-up, over and above MMSE scores, demographic characteristics, mood, and treatment assignment (beta = -. 26***).

ADLs Beta Bathe or shower . 12 Dress from waist up -. 06 Dress from waist down -. 06 Grooming . 11 Using toilet -. 05 Eating -. 11 IADLs Housework . 15 Shopping . 01 Using the telephone . 28** Taking medication -. 21* Preparing meals . 02 Managing finances . 04 Mobility Getting in/out of car . 20 Walking indoors -. 08 Walking 1 block -. 07 Climbing 1 flight of stairs -. 45*** Moving in/out of chair . 01 Moving in/out of bed -. 12

Types of Activities Baseline difficulty with using the telephone was predictive of MCI at 12 months. Paradoxically, MCI was inversely associated with difficulty climbing stairs and taking medication: Cognitively impaired people reported less difficulty with these IADLs. These inverse relationships were unexpected and are difficult to interpret. Individuals with no cognitive impairment may be performing those tasks more than others and therefore be reporting more difficulty with them.

Types of Adaptations Beta Use of assistive devices Receiving help from others . 12. 26** Change in frequency Change in way of performing task -. 11 -. 03

Types of Adaptations Receiving help from others was the only type of adaptation at Baseline to predict MCI scores at 12 months. This is especially interesting in light of research indicating that families of mildly cognitively impaired elders report greater burden.

Implications n Elderly people whose participation in discretionary activities (social engagements, hobbies, or exercise) has declined, or who require help with activities of daily living, should be considered at risk for MCI and be evaluated. Families who notice such changes should be queried about this aspect of functioning. n This practice would provide older adults and their families the opportunity to receive treatment that may delay the onset of MCI and plan for the future. n The paradoxical findings regarding climbing stairs and taking medication should be explored in future research.